B 0389 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO RIBLUING-ULECfRICAL PHRM No. 0389
APPLICATIONIPERMIT PLUMBING-MECHANICAL nn
BUILDING DIVISION BUILDING PROJECTIDEN'EIFICATION 50001
SAN[I'ARY NO. APPLICATION SUBMITTAL DAI'IT
BUILDING ADDRESS:
OWNER'S NAME: 1'"ONE` CONTRACTORIS NAME LIC NO: SIC CONI'ROI.N
c tlN6 dlaJG// �4/,s/`a6'u$€ ❑ l 3 ��
ARCI 1'li(;�/ NGNVIiR:
UC No / ADDRESS:
COM'oACT: I IIOZ. 3 BUILDING PERh11'f INFO
40btr 4- n /O' D/ p ❑ Consultant Fecs Paid by Applicant(Initial) Rz LDO _ ELP2, Mec
/�LICENSED CONTRACTOR'S DECLARATION C Q'f Y. ELECTRIC PERMIT FEL JOB DESCRIPTION
1 hereby affirm that I.,it Imcencel under Pnrvixin is or Chapter 9(commencing
CKZ with Sumo.7000 afDivi,km3offim 90.dvassand Pmurctrns Gde.and all is RESIDENTIAL:
PERMIT ISSUANCE
Iw-U0- full force and effect. ❑SED\Vit ❑KI'PCIiIiN RIiMUDIiI.
0. F an
QU(� License Chris Lic.Y APPLIANCES-RP_SIDEM'IAI. [I ADDITION ❑PLUMBING R6PII'li
HZwj Date r ❑MULI'bI1NIT ❑STRUCI'l1RAh
A : ITC )N
CTS DPANELSe- //�\ MODII§CAT[ON
D000a
Z O y Z I unJcrstand a,boll bo u: bis ores UPTO 200AMPS p[p 1 /
OZonO 11 ❑INTERIOR ❑CHIMNEYREPA1R
1-�.~.W l.icen Pmlc,, 201-1000AMPS IMPROVEMENT E:]SWIMMING POOLS
OWNER BUILDER DECLARATION OVER Lod AM13S ❑BATH KEMODEI/REPAIR ❑DEM01.1IION
1 hereby aRnn that I am exempt from the Contractor's License hw for the ❑OTHER
I U following oasvm.(Section 7031.5.Buslvess and Yofessiane Cade:Any any or county SIGNS ELECTRICAL
a W vii m which requires a permit to mistrust,ollcr,Ingrtove denailkh,or reform,any stardom
�cI proI s asrequirestit optic tf hp mita file :g mm
dsmteSPECIALCIRCUIUMI C.
f } but he licensed stonsc '..he Provisions fib C t art's Lm n- I (Chronic" COMMERCIAL:
ad (commencing with Sect_ 7000) f1l sii J fN B : ss dlr f.. ns Cide)or TEMP.METER OR I'OIJ V.
d y
29 thin he is txempl therelrn;Or nnJ dm boli,for the alleged eacmPeon.Any violation of [:]NEW SLUG/ADOPTION ❑UEh101,IT10K
aa=H Section]1U1.5 by any aPPlicam fore,emtit.,ubjecl.c the ap,licanno ucivil p<•nally of POWER DEVICES 'ITNANI' ❑FOODSERVICE
not mom than Eve hundred dollars(S500). MVROVEMEN'
ESD ❑I.esnwnerluf the property,or my cmrbyces with wage.cm their one comrenwlion. SWIMMINGP(H)LF.LECI'RIC
will Jo the work,and me,truclum k nol unraded or offered or sale(See.Tim,Business ❑OTHEk
CF"o OUTIJiIS-SWI'FOIES-II%'I'UBLS qq 00
�3 m and Professions Code:The ComnmeRs License law Jams not apply vi an owner of Q V l
property who builds or improves thereon.and who does each work himself or through NEW RESIDENTIAL ELECTR SQ PT.
his own employees.provided that such imPovenments art not intended or nffemed for SQ IT FL REA VSQ.1'1'.
sole.If,howavcm the hadding or impnwcamet le sold within one year of completion,the
swnerbuilill will have the burden of proving that he Aid not hum ld or improve lin pur- /
piss omwet
1,aseowner of the proPcny,ren exclusively contracting with licensed contractors to /
congmut the pmnfst(lice.71K4.Ibdine,s mal Palm sine,Cade:)The ComicalLi-
cerise law does not apply m an ownerof preperty who buildsnr improve,therein,and O 'RMI'I' PEE /
who romocufor inch projects with aconlrumoCp license)pumm�uothe Cano-dors ..r
License l.aw. T IANC,
0
at unc;npt under Sec. .R&PC for this reason 5 r xsN
.,1 ALI'IiN�URs A R ' VAI,UAI'ION
Owner Ude
• WORKER'SCOSIYENSA'I'ION DECLARATION tI ,BA(T Ao I Cp U1.
J I hercbyatr nn amer,mak,of penury onent rite lblmwin mon.. V VV
I have and will mammuin aCenlfieareof Consonrtn selhirvai Gm rake's Co;npca- 1 INS-Il( ARHA,COND. S'11ORIIiS 'PYPIT CONS'TRUCI'ION
satmom as provided for by Section 37W of the Labor Cade,for the 1 of the .I RES-PER TRAP
work for which this Petmn is issued.
0 1 have and will maintain Worked Contiou-nion Irionam e,as mala I by Section GAS-ITA.SYS'I EM-I INCA OUTLETS OCG.GRDGP APN
3700afthe Labor Cntlef..the lostoranance ofthe work farwhich this his
My Worms to pc lion Insurance carrier and Policy numberor. . GAS-EA.SYS'1TM OV12H 4(EA)
Cumcr. Policy No.:
C14I0119CATF OP E%EMPTION FRO KERS' GREASE/INDUS'I'RL WASTE INTERCEPTOR
COMPENSATION INSURANCE? ItU1LUIN0 DIVISION FHHS
(This section need not bccontplead ifthepermit k1oronchundreddollms(SIW) GREASE TRAP PLANCIIRCK FCIT 2
or les.)
n71i1'y rM1ot in the perlbrnn;ncc of the wire...which to thepermitWorkers
on,mrl SEWITR-SANITARY-STORM P.A. IT. ITNhRGY FEE
i not employ any pemm in troy manner so as ei bccon¢m;hjcn ei the Workers'Compen-
Z no.Laws of California.Date WA'I'12R HIfAl ER WNEKI ELCCFR GRADING LITE
ZO Applicant )
h NOTICE 10 APPLICANT:11,after making no;Ccnifcmc of E.c......a.you should WATER SYS"1'ITM(fREA'I'INC. SOILS PELT
abecome uabjed hr the Wnrlo is Cnmpensatian provisions of the Labor Calc,you most
r forthwith comply with such Provision,onhis permit shall be deemed revoked. WATER SERVICE
a PAID
CONSTRUCTION LENDING AGENCY NIiW RESIDENTIAL,LMR. SQ.PI'' Look Receipt p
U 0 (hereby affirm that Is a constmetiot lendingagency for the Performance of
V. F" the isork for which this Permit is issued(See.3091.Co.C.) l17 lender',Name TO I
LUL] Lender's AAd...s BUILDIN' EF
6. I eenmfy that I have read this appllcanon and seam that thumboe infornmtion is
N ronect.l agree to comply with all city and county luminances and state laws relining to QTY. MECHANICAL PERMIT FEE SIHSMLC FEE
U Z building construction.and hereby aumorimrepre.enlalmes of this city to evocation the
ahava:.meatlanw pamcnacdan y for inspPar,soO,, PERMIT ISSUANCE ELECTRIC C)
1 We)agree ai,act.laden mify and lots,harmlea the City )I Capcnino agnm,l
liabilities.judgemenu,costs and expenses x hich may in any way accrue against said City ALTER OR ADD'TO MSCI I. PLUMBI IFF Q Q
moque me of the granting n(this permit.
mAPPI.ICAN'I UNDERSTANDS AND rol,IOTUMPLY WD 11 ALL NON-POINT AIR HANDLING UNIT LTO I0,(IMI CFM) MECHANIC LITIT
SOURCEREGUI.AI' )NS.
AIR HANDLING UNIT(OVER 10,0kI CFM) CONS]RUM ION'TA%
SlgnatareofAr 'neall/pmmumlor 'eDs•// I.;u It
IIAUSI HOOD(W/DUCT) HOUSING MITIGATION FCR
HAZARDOUS MAI'ITRIALS DISCLOSURE
Will the applicant or future building oveaPaol some or handle hic amom i materialUNIT(TO I00.INIB BTU)
as Joined by the Calcium,Mo(y iral Code.Clool 9.12.and the Health and SafetyUNIT(OVER 100.0(1 BTUI
Cade.Section 2553200" /
(]Yes ❑Nn - ION I AN(SINGLE BIT PAID .i .N
Dnlc
WII the ap,licaa,or fnmre building miccupent use equipment or devices which BOILER CHP OR 100.IXX1 BTU)
I�emit hw.unlo.,air svmmn uunall nJ�hfned by the Buy Area Air Quality Mar"Orram
Dhtrim] / COMP InjM0 B'I'U)
C]Yes No
ITIONER ISSUANCIi DATE
have rend the helaidau,lueelials mquircancnls under Ch;Nter 6.05 of the Cul l- p
forma Hwph A Salify Cidc,Sections 255115,2557}and 2594.I undcnwnJ tbm it Ih° IDEN'1'IA,MECI I. SQ.I'1'.
building does no currently have tenant.that it is my revionsihilitym notify the tecupatn L(f
of the myuiremenhich most he rte: n mssuarmee,1�Cen iu of OyFupancy.
S % /—/LI�Jj
Owner or uJNom<d agem
Uulc 'TQI'AL: ISSUED BY:
OFFICE